Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
Yokohama City Institute of Public Health, Yokohama, Japan.
Arch Osteoporos. 2018 Aug 29;13(1):94. doi: 10.1007/s11657-018-0509-6.
This study's purpose was to clarify the cost-effectiveness of osteoporosis treatment. Denosumab treatment was cost-effective compared with alendronate treatment for elderly Japanese women at high risk of fragility fractures. Denosumab treatment might be cost-effective for patients with lower bone mineral density.
In Japan's super-aged society, the prevention and treatment of osteoporosis are a critical issue with implications for the medical economy. This study's purpose was to clarify the cost-effectiveness of osteoporosis treatment with denosumab versus weekly alendronate for elderly Japanese women at high risk of fragility fractures.
A Markov model was used for simulation analysis. The modeled population was 75-year-old Japanese women with a bone mineral density (BMD) of 65% of the young adult mean (YAM) (T-score, - 2.87) and a history of previous vertebral body fracture. The simulation model was repeated until patient age reached 100 years or death. Analysis was performed from the societal perspective. Costs and epidemiological data were derived from previous studies. The incremental cost-effectiveness ratio (ICER) was calculated from the simulation. We compared the ICER with willingness-to-pay. Additional analyses were performed with different combinations of age and BMD. Sensitivity analysis verified the robustness of the analysis.
For the modeled population, the ICER of denosumab versus alendronate treatment was estimated at US$40,241/quality-adjusted life year (QALY). The ICER of denosumab for 80-year-old women whose BMD was 60% of YAM was estimated at US$22,469/QALY.
Assuming willingness-to-pay as US$50,000/QALY, denosumab treatment for 75-year-old Japanese women with a BMD of 65% of YAM and a history of previous vertebral body fracture was cost-effective compared with alendronate treatment. Among over 75 years of age, denosumab treatment might be more cost-effective than alendronate for patients with a BMD of 65% of YAM or lower.
在日本的超老龄化社会中，骨质疏松症的预防和治疗是一个对医疗经济具有重要意义的问题。本研究旨在明确地舒单抗与每周阿仑膦酸钠治疗日本老年骨质疏松高危脆性骨折女性的成本效益。
采用马尔可夫模型进行模拟分析。模型人群为骨密度（BMD）为年轻成人平均值（YAM）的 65%（T 评分，-2.87）且有既往椎体骨折史的 75 岁日本女性。模拟模型重复进行，直至患者年龄达到 100 岁或死亡。分析采用社会视角。成本和流行病学数据来自先前的研究。从模拟中计算增量成本效益比（ICER）。我们将 ICER 与支付意愿进行了比较。还进行了不同年龄和 BMD 组合的附加分析。敏感性分析验证了分析的稳健性。
对于模型人群，地舒单抗与阿仑膦酸钠治疗的 ICER 估计为 40241 美元/质量调整生命年（QALY）。对于 BMD 为 YAM 的 60%的 80 岁女性，地舒单抗的 ICER 估计为 22469 美元/QALY。
假设支付意愿为 50000 美元/QALY，与阿仑膦酸钠治疗相比，地舒单抗治疗 BMD 为 YAM 的 65%且有既往椎体骨折史的 75 岁日本女性是具有成本效益的。对于 75 岁以上的人群，对于 BMD 为 YAM 或更低的患者，地舒单抗治疗可能比阿仑膦酸钠更具成本效益。
